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Biomedical subjects

L Carey

Publications and source records attributed to L Carey.

At least 19 recordsLinked to original sources
PubMed2003

Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum.

BACKGROUND: We evaluated outcome after laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication. METHODS: Patients with symptomatic achalasia and epiphrenic diverticula underwent laparoscopic diverticulectomy, Heller myotomy, and partial fundoplication. Intraoperative endoscopy and postoperative esophagography were performed in all patients. Patients graded preoperative and postoperative dysphagia and heartburn on a Likert scale. RESULTS: Anterior fundoplication was performed in five patients and posterior fundoplication in one. Mean follow-up was 9 months (range, 1-17 months). One intraoperative complication occurred--an esophagotomy that was laparoscopically repaired. There were no postoperative leaks. Patient-reported dysphagia decreased from 4.5 +/- 0.8 (mean +/- SD) to 1.8 +/- 1.7 ( p < 0.05 matched pair analysis). Heartburn decreased from 4.3 +/- 0.8 to 1.3 +/- 1.3 ( p < 0.05). All patients reported improvement in symptoms after operation. CONCLUSION: Laparoscopic esophageal diverticulectomy, Heller myotomy, and partial fundoplication with intraoperative endoscopy safely reduce dysphagia associated with achalasia and esophageal diverticula while limiting symptoms of gastroesophageal reflux.

Adult↗
PubMed2001

Delay in treatment of biliary disease during pregnancy increases morbidity and can be avoided with safe laparoscopic cholecystectomy.

Recent reports indicate that laparoscopic cholecystectomy in pregnancy is safe. The aim of this study was to evaluate whether delays in definitive treatment of symptomatic cholelithiasis increase morbidity. We reviewed the records of 16 women who underwent laparoscopic cholecystectomy during pregnancy between 1992 and 1999. Mean age was 24 +/- 5 years (mean +/- standard error). Symptom onset was during the first trimester in nine patients, second trimester in six patients, and third trimester in one patient. Patients had abdominal pain (93%), nausea (93%), emesis (80%), and fever (66%) for a median of 45 days (range 1-195 days) before cholecystectomy. Nine of 11 women who underwent cholecystectomy more than 5 weeks after onset of symptoms experienced recurrent attacks necessitating 15 hospital admissions and four emergency room visits. Moreover four women who developed symptoms in the first and second trimesters but whose operations were delayed to the third trimester had 11 hospital admissions and four emergency room visits; three of those four (75%) women developed premature contractions necessitating tocolytics. Cholecystectomy was completed laparoscopically in 14 women. There was no hospital infant or maternal mortality or morbidity. We recommend prompt laparoscopic cholecystectomy in pregnant women with symptomatic biliary disease because it is safe and it reduces hospital admissions and frequency of premature labor.

Adult↗
PubMed1999

Do health checks cause stress?

Data are reported concerning social responses to health checks in an occupational setting. Previous research has suggested that screening may be a stressful experience. This, in turn, has contributed to a degree of scepticism about the value of health checking. No evidence was found in the present study to support the proposition that health checks cause such responses. It is shown that health checks prompt recipients to try to engage in health promoting behavioural changes. The study was a randomized controlled trial of 1,371 persons employed in a large engineering factory in the West of Scotland.

Engineering↗
PubMed1998

Endoscopic third ventriculostomy: an outcome analysis.

Endoscopic third ventriculostomy (ETV) has gained widespread acceptance as an effective way to manage hydrocephalus in selected patients. To determine which patient groups have the highest chance of successful ETV, a retrospective case review was performed. From June 1992 to December 1996, 97 patients underwent a total of 98 ETVs at our institution. There were 59 males and 38 females with a mean age of 8.1 years (range 1 day to 29.5 years). Twenty-six of 98 procedures (26%) were abandoned due to either unfavorable anatomy, inability to perform a cisternostomy, or hemorrhage. Follow-up data was available in 92 patients for a mean of 24.2 months. The rate of successful ETV in 71 patients, with either complete shunt avoidance or removal, varied widely by diagnosis and patient age. The highest success rates were achieved in patients with aqueductal stenosis, tectal plate tumor, myelomeningocele and posterior fossa tumor. Complications included one transient herniation syndrome, one basilar artery perforation, 2 cases of ventriculitis, one transient decrease in level of consciousness, and one transient hemiparesis. We feel these results support the continued use of ETV in only carefully selected patients with hydrocephalus.

Adolescent↗
PubMed1997

Peptide mimicry of adenocarcinoma-associated carbohydrate antigens.

Carbohydrate antigens have been identified as significant antigens in many human tumors either by analyzing antibodies in patients' sera or by using monoclonal antibodies of either mouse or human origin. Three carbohydrate epitopes present on cancer-associated mucins [sialyl-Lewis A (SLA), sialyl-Lewis X (SLX), and sialyl-Tn (STn)] may have functional significance in metastasis. Subsequently, these antigens are considered as targets for active specific immunotherapy. Carbohydrates, as T-cell-independent antigens, often elicit diminished immune responses. To overcome this drawback, carbohydrates are typically coupled to protein carriers to elicit immunoglobulin G (IgG) responses as opposed to low-affinity IgM responses, which often times accompanies carbohydrate-based immunizations. In addition, some complex carbohydrates are difficult to synthesize. This latter aspect is further magnified if one considers that clustering of epitopes on neoglycoproteins must be emulated in the synthesis process, leading to multiple presentation or tandem repeats of the synthetic carbohydrate immunogen. Here, we examine the hypothesis that peptides that mimic carbohydrates might be developed to induce immune responses that target and mediate the killing of tumor cells, particularly breast cancer cells in an adjuvant-type setting. We have found that carbohydrate-mimicking peptides retain carbohydrate-like conformations, inducing anti-carbohydrate immune responses against breast tumor cells and mediating their killing by a complement-dependent mechanism.

Adenocarcinoma↗
PubMed1995

Health checks and coronary risk: further evidence from a randomised controlled trial.

OBJECTIVE: To determine the effectiveness of a health check and assess any particular benefits resulting from feedback of plasma cholesterol concentration or coronary risk score, or both. DESIGN: Randomised controlled trial in two Glasgow work sites. SUBJECTS: 1,632 employees (89% male) aged 20 to 65 years. INTERVENTIONS: At the larger work site, (a) health education; (b) health education and feedback on cholesterol concentration; (c) health education and feedback on risk score; (d) health education with feedback on cholesterol concentration and risk score (full health check); (e) no health intervention (internal control). At the other work site there was no health intervention (external control). MAIN OUTCOME MEASURES: Changes in Dundee risk score, plasma cholesterol concentration, diastolic blood pressure, body mass index and self-reported behaviours (smoking, exercise, alcohol intake, and diet) in comparison with internal and external control groups. RESULTS: Comparisons between the full health check and the internal control groups showed a small difference (0.13 mmol/l) in the change in mean cholesterol concentration (95% confidence interval 0.02 to 0.22, P = 0.02) but no significant differences for changes in Dundee risk score (P = 0.21), diastolic blood pressure (P = 0.71), body mass index (P = 0.16), smoking (P = 1.00) or exercise (P = 0.41). Significant differences between the two groups were detected for changes in self-reported consumption of alcohol (41% in group with full health check v 17% in internal control group, P = 0.001) fruit and vegetables (24% v 12%, P < 0.001), and fat (30% v 9%, P < 0.001). Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score, or both. CONCLUSIONS: The health check only had a small effect on reversible coronary risk. It was effective in influencing self reported alcohol consumption and diet. Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour.

Adult↗
PubMed1995

Pediatric cervical spine instrumentation using screw fixation.

From July 1986 to August 1993 we performed 24 pediatric cervical spine screw fixation procedures on 23 patients 16 years of age or less. The types of cervical instrumentation procedures performed were as follows: anterior cervical plates 12, posterior C1-2 screw fixations 8, posterior lateral mass plates 2, odontoid screw fixations 2. The mean age of all patients was 14.2 years (range 6-16). Indications for operation included traumatic instability in 20 cases, congenital instability in 1 case, 2 cases of postoperative swan neck deformity, and one reoperation for early graft and hardware failure. Six of the 23 patients had persistent instability following previous failed fusions (3 with 1 prior surgery, 2 with 2 prior surgeries, and 1 with 3 prior surgeries). Eight patients had improvement of their neurological status following operation and 15 remained at their preoperative level of neurological function. No patient was worse neurologically after their procedure. There were no long-term instrumentation, graft or fusion failures. Two complications occurred. One was the aforementioned graft and hardware failure requiring reoperation, the other was a superficial wound infection treated successfully with antibiotics. We feel that cervical spine fixation techniques have increased our ability to stabilize the pediatric cervical spine and have proven to be safe and effective.

Adolescent↗
PubMed1994

Experience with the Gianturco-Roubin stent for abrupt vessel closure complicating percutaneous transluminal coronary angioplasty.

BACKGROUND: Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTCA), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG. AIM: To assess our initial experience with emergency coronary artery stenting as a new technique. METHODS: Retrospective case study review with clinical and angiographic follow-up. RESULTS: The Gianturco-Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow-up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one. CONCLUSIONS: The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1988

Patient anesthesia and monitoring at a 1.5-T MRI installation.

This paper describes the facilities successfully used to provide patient monitoring and anesthesia support in a 1.5-T imaging installation. The requirements for the MRI site for anesthetic gases, shielded power, and radiofrequency ports are outlined. Specific modifications in anesthesia machines, anesthesia cart, laryngoscope, mercury sphygmomanometer, oximeter, and remote blood pressure devices are described. Additional aspects of patient monitoring and support, e.g., electrocardiogram and pressure infusion, are also discussed.

Anesthesiology↗
PubMed1987

Amelioration of pulmonary pathophysiology of adult respiratory distress syndrome by sulindac, a cyclo-oxygenase inhibitor.

The effects of sulindac, a cyclo-oxygenase inhibitor, were tested in a bacteremic porcine model of acute respiratory failure produced by a continuous infusion of live Pseudomonas aeruginosa. Control groups received either a single intravenous dose of sulindac (6 mg/kg) 20 minutes after baseline determinations or a continuous infusion of Ps. aeruginosa (10(7) CFU/kg/min) beginning at time 0. The experimental group received both. Sulindac alone had no effect on any hemodynamic or gas exchange parameter. Ps. aeruginosa infusion caused pulmonary hypertension, hypoxemia, increased intrapulmonary shunt fraction, systemic hypotension, and increased extravascular lung water. Sulindac treatment reversed the pulmonary hypertension, hypoxemia, and increased intrapulmonary shunting, prevented the systemic hypotension, but had no effect on the rising extravascular lung water.

Animals↗
PubMed1981

Super-obesity: a psychiatric profile of patients electing gastric stapling for the treatment of morbid obesity.

This is a preliminary report designed to identify personality characteristics which are unique to those super-obese electing a surgical intervention for weight loss. We have laid the groundwork to determine prognostic signs for the success or failure of the gastric stapling surgical technique for the treatment of morbid obesity, Self-report rating scales, demographic data forms, and MMPI's were administered to super-obese subjects and psychiatric consultations performed preoperatively and at various intervals postoperatively. Patients report satisfaction with their weight loss and few physical or psychological complications in the immediate post-op period. The MMPI and psychiatric consultations identify fairly high levels of psychopathology in this group. An aggregate psychiatric profile of the female and male morbidly obese patient is discussed.

Adult↗
PubMed1979

The spectrum of liver disease on CT.

Computed tomography (CT) is a useful imaging modality in a variety of liver diseases. The roles of radionuclide liver scanning, ultrasound and CT in liver disease are discussed and characteristic CT findings of cystic disease, trauma, abscess, primary and metastatic malignancy, fatty infiltration, hemochromatosis, and obstructive jaundice are illustrated.

Adolescent↗
PubMed1977

The adverse effects of elemental diets on tolerance for 5-FU toxicity in the rat.

The effects of a group of elemental diets on the gastrointestinal toxicity of 5-FU in the Sprague-Dawley rat were evaluated. Diarrhea, stomatitis, hypoalbuminemia, and early deaths were more frequent in the animals on elemental diets than in those consuming standard rat chow. Sepsis and hypoalbuminemia were directly related to the extent of protein hydrolysis of the particular elemental diet.

Amino Acids, Essential↗